Propoxyphene

Propoxyphene Brand Names- Darvon | Darvon-N 100 | PP-Cap

What is Propoxyphene

Propoxyphene is a synthetic opiate agonist. Structurally, propoxyphene is more similar to methadone than to morphine.

Compared with codeine, propoxyphene is one-half to two-thirds as potent an analgesic. An equivalent analgesic dose of propoxyphene to morphine 10 mg IV would be too toxic to administer.

High doses of propoxyphene are limited by serious side effects and toxic psychosis. Propoxyphene is as effective or is less effective than 30—60 mg of codeine or 600 mg of aspirin. In addition, overdoses of propoxyphene can be more difficult to reverse than overdoses of traditional opiates.

Propoxyphene exerts little or no antitussive activity and may cause an increased incidence of seizures compared to other opiate agonists. In patients physically dependent on other opiate agonists, propoxyphene will only partially suppress the withdrawal syndrome.

Propoxyphene was approved by the FDA in 1957.

Use of propoxyphene has declined due to the availability of more effective agents. In addition, cardiac rhythm abnormalities have been associated with propoxyphene use in post-marketing experience of over-dose cases and in targeted safety studies of therapeutic use conducted in 2009—2010

As a result, the FDA requested a market withdrawal of all products containing propoxyphene in November 2010, stating that propoxyphene risks outweigh its benefits.

Health care providers are encouraged to stop prescribing propoxyphene products and patients are encouraged to contact their prescribers for alternative therapy

Indications

1. arthralgia
2. bone pain
3. dental pain
4. headache
5. migraine
6. mild pain
7. moderate pain
8. myalgia

Side Effects

1. arrhythmia exacerbation
2. blurred vision
3. bradycardia
4. cardiac arrest
5. cholestasis
6. coma
7. confusion
8. constipation
9. diaphoresis
10. dizziness
11. drowsiness
12. elevated hepatic enzymes
13. flushing
14. headache
15. heart failure
16. jaundice
17. myocardial infarction
18. nausea
19. neonatal opioid withdrawal syndrome
20. orthostatic hypotension
21. palpitations
22. physiological dependence
23. pruritus
24. psychological dependence
25. psychosis
26. QT prolongation
27. rash
28. respiratory depression
29. restlessness
30. seizures
31. sinus tachycardia
32. syncope
33. tissue necrosis
34. tolerance
35. vomiting
36. withdrawal

Monitoring Parameters

• serum creatinine/BUN

Contraindications

• abrupt discontinuation
• accidental exposure
• alcoholism
• angina
• asthma
• biliary tract disease
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• chronic obstructive pulmonary disease (COPD)
• coadministration with other CNS depressants
• constipation
• depression
• diarrhea
• driving or operating machinery
• geriatric
• GI disease
• GI obstruction
• head trauma
• heart failure
• hepatic disease
• hypotension
• hypovolemia
• ileus
• increased intracranial pressure
• infants
• inflammatory bowel disease
• labor
• neonates
• obstetric delivery
• oliguria
• opiate agonist hypersensitivity
• potential for overdose or poisoning
• pregnancy
• prostatic hypertrophy
• pulmonary disease
• QT prolongation
• renal disease
• renal impairment
• respiratory depression
• respiratory insufficiency
• seizure disorder
• seizures
• substance abuse
• suicidal ideation
• tobacco smoking
• ulcerative colitis
• urethral stricture
• urinary retention

Interactions

• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Diphenhydramine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Tramadol
• Acrivastine; Pseudoephedrine
• Aldesleukin, IL-2
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Alogliptin; Metformin
• Alosetron
• Alpha-glucosidase Inhibitors
• Alvimopan
• Amide local anesthetics
• Amifampridine
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine
• Amlodipine; Atorvastatin
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amoxapine
• Anxiolytics; Sedatives; and Hypnotics
• Apomorphine
• Apraclonidine
• Artemether; Lumefantrine
• Articaine; Epinephrine
• Aspirin, ASA; Oxycodone
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Azelastine
• Azelastine; Fluticasone
• Benzodiazepines
• Benzonatate
• Benzphetamine
• Bethanechol
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Brimonidine
• Brimonidine; Brinzolamide
• Brimonidine; Timolol
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
• Bupropion; Naltrexone
• Buspirone
• Butorphanol
• Canagliflozin; Metformin
• Carbamazepine
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carvedilol
• Cetirizine
• Cetirizine; Pseudoephedrine
• Cevimeline
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chloral Hydrate
• Chlorcyclizine
• Chloroprocaine
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone; Clonidine
• Cimetidine
• Citalopram
• Class IC Antiarrhythmics
• Clemastine
• Clomipramine
• Clonidine
• Clopidogrel
• Clozapine
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Crofelemer
• Cyclizine
• Cyclobenzaprine
• Cyproheptadine
• Dapagliflozin; Metformin
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Delavirdine
• Desflurane
• Desipramine
• Desmopressin
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmedetomidine
• Dexpanthenol
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Dorzolamide; Timolol
• Doxepin
• Doxercalciferol
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Dutasteride; Tamsulosin
• Eltrombopag
• Eluxadoline
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Enflurane
• Ertugliflozin; Metformin
• Escitalopram
• Esketamine
• Estrogens
• Eszopiclone
• Ethanol
• Ethotoin
• Etomidate
• Fesoterodine
• Flibanserin
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Fosphenytoin
• Gabapentin
• Glipizide
• Glipizide; Metformin
• Glyburide; Metformin
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guanabenz
• Guanfacine
• Haloperidol
• Halothane
• Homatropine; Hydrocodone
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Ibuprofen; Oxycodone
• Iloperidone
• Imatinib
• Imipramine
• Indinavir
• Insulins
• Isocarboxazid
• Isoflurane
• Itraconazole
• Ixabepilone
• Ketamine
• Ketoconazole
• Levobupivacaine
• Levocetirizine
• Lidocaine
• Lidocaine; Prilocaine
• Linagliptin; Metformin
• Lincosamides
• Lisdexamfetamine
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Loxapine
• Lumateperone
• Lurasidone
• Magnesium Salts
• Maprotiline
• Maraviroc
• Meglitinides
• Meperidine; Promethazine
• Mepivacaine
• Mepivacaine; Levonordefrin
• Meprobamate
• Mesoridazine
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methadone
• Methamphetamine
• Methyldopa
• Metoprolol
• Metyrapone
• Metyrosine
• Mexiletine
• Minocycline
• Mirtazapine
• Molindone
• Nabilone
• Nalbuphine
• Naloxone
• Naltrexone
• Nefazodone
• Nesiritide, BNP
• Nitroglycerin
• Nortriptyline
• Octreotide
• Olanzapine
• Ombitasvir; Paritaprevir; Ritonavir
• Oxycodone
• Oxymorphone
• Paliperidone
• Papaverine
• Peginterferon Alfa-2b
• Pegvisomant
• Pentazocine
• Pentazocine; Naloxone
• Perindopril; Amlodipine
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenothiazines
• Phenylephrine; Promethazine
• Phenytoin
• Pimozide
• Pramlintide
• Prasugrel
• Pregabalin
• Prilocaine
• Prilocaine; Epinephrine
• Procaine
• Procarbazine
• Prochlorperazine
• Promethazine
• Propranolol
• Protriptyline
• Quetiapine
• Quinidine
• Quinine
• Ranolazine
• Rasagiline
• Risperidone
• Ritonavir
• Ropinirole
• Ropivacaine
• Safinamide
• Saquinavir
• Selegiline
• Sevoflurane
• Sildenafil
• Sodium Oxybate
• Spironolactone
• Tamsulosin
• Tapentadol
• Terbinafine
• Tetrabenazine
• Tetracaine
• Thalidomide
• Thiazolidinediones
• Thiethylperazine
• Thioridazine
• Thiothixene
• Ticagrelor
• Timolol
• Tipranavir
• tobacco
• Tolterodine
• Tramadol
• Tranylcypromine
• Trazodone
• Tricyclic antidepressants
• Trifluoperazine
• Trimethobenzamide
• Trimipramine
• Triprolidine
• Trospium
• Valerian, Valeriana officinalis
• Vigabatrin
• Vilazodone
• Warfarin
• Zaleplon
• Ziconotide
• Ziprasidone
• Zolpidem